NDS Neurodynamic Solutions

🔥🔥🔥DID YOU KNOW? Applying neural tension in one area can DECREASE it in another.

1. MISCONCEPTION - A long-held misconception has been that applying tension along a nerve always increases tension in the connected nerves and nerve roots. This is sometimes incorrect because the nerve movements in other areas depend on the anatomy and biomechanics where angles and displacements change.

2. MECHANISM - As a nerve is tensioned distally, the nerve roots on the same side and spinal cord follow caudally. This cord movement can pass a reduction in tension to the nerve root on the other side.

3. NEURODYNAMIC RESPONSES - Neurodynamic test responses can reflect this reduction in tension. Knee extension during the slump test can reduce the neurodynamic response on the other side.

Reductions in neurodynamic responses:

- contralateral slump test - almost all subjects (Shacklock et al 2016, it was 100% but not likely when applied to larger population).
- bilateral leg raise - upper limb responses - 67% (Bell 1987).
- contralateral upper limb neurodynamic test - 62% (Rubenach 1984).

4. MPLICATIONS AND APPLICATIONS - Here are several uses for the mechanism:

a. b. c. Interpretation - bilateral techniques can be a lower progression than ipsilateral ones.

Diagnosis - contralateral nerve movements can be used to corroborate neurodynamic responses.

Treatment - techniques can be used to reduce tension for pain relief.

5. TECHNIQUE - How you do the technique is critical because small changes in technique can produce big changes in the result.

Video - here is an example of the bilateral straight leg raise.

MID-LUMBAR RADICULOPATHY
Neurodynamic Testing - Prone Knee Bend

Here we go through several key points about neurodynamic testing for the mid-lumbar nerve roots.

1. MID-LUMBAR RADICULAR PAIN - Radicular pain from the mid-lumbar nerve roots can be tested with the PRONE KNEE BEND (PKB).

The PKB applies distal tension to the lumbar nerve roots (L2-4) through their innervated tissues (quadriceps) and can reproduce mid-lumbar pain.

2. PROBLEM - The pelvis rotates anteriorly through the re**us femoris muscle pulling distally on the ASIS. This means that the PKB is NOT SPECIFICALLY A NEURODYNAMIC TEST.

In principle, it’s the same as the SLR, which is why we use ankle dorsiflexion to differentiate neural movements because the SLR also produces pelvis movement (posterior rotation) with the hamstring mechanism.

3. SOLUTION - Turn the PKB into a neurodynamic test:

This applies to mid-lumbar pain only because the mechanisms in the other parts of the Neuro-MSK chain are different.

STEP 1 - Do the PKB and LET THE PELVIS MOVE and the mid-lumbar pain happen. Observe the direction of movement and plan your next move.

STEP 2 - Stabilise the pelvis to stop the spine moving. This is based on the movements you observed. This stabilisation reduces the MSK contribution to the mid-lumbar pain.

STEP 3 - Interpret the response.

IF - Back pain stops when the spine is stabilised, the interpretation is that it may have a significant MSK aspect.

IF - Back pain repeats or increases when the spine is stabilised, the interpretation is that it may have a remaining neural aspect because the nerve roots are still tensioned distally with the PKB.

SOMETIMES WE MISS THE NERVE, especially in high-functioning patients such as athletes when the problem is caused by pressure from the adjacent muscle.

NERVE FLOSSING - There is a lot of material out there on “nerve flossing”. These techniques are basically neural mobilisation and are, in part, artificial, or at least, incomplete because people don't normally move that way.

MOVEMENT - Muscles normally apply pressure to nerves but it's when the pressure becomes excessive or the nerve can't tolerate the force that symptoms develop. The most common cause of radiculopathy and neuropathy in the MSK context is compression which, when combined with movement, can also irritate the nerves. Compression can be caused by the piriformis muscle.

Standard slump test - The standard slump test elongates the sciatic nerve instead of reproducing compression by the muscle and nerve flossing mostly slides the nerve so these are not specific to the problem. We need something better that targets the interactions between the muscle and sciatic nerve.

PIRIFORMIS SLUMP TEST

Who is it aimed at?

This aimed at high function people with isolated buttock pain; no referred pain, no neurological symptoms. These patients often don't have any symptoms that suggest neural involvement so we often don't test for it. Instead, we treat the muscle by default.

TWO PROBLEMS THAT FAIL THE DIAGNOSIS.

A. Not testing neurodynamics because there are no symptoms of a neural problem.

B. Only doing basic or standard testing "... just to exclude the nerve".

This can miss the neural aspect because it's not testing the neurodynamics at the patient's high level of function.

SOLUTION - here is how to solve the problem.

1. Test standard slump first:
- What to look for: reproduction of symptoms - usually buttock and upper/lateral thigh.
- See If differentiation supports a neural aspect.

2. If this doesn't find anything (which is common in high function patients), you can do the piriformis slump test.

PIRFORMIS SLUMP TEST

Aims
- Test the nerve and muscle together.
- Apply pressure to the nerve during the neurodynamic test.
- Test the interactions between the muscle and nerve instead of one system in isolation.
- Target the nerve by reproducing the patient's relevant movements.

How To Do It

- Set the patient up for the standard slump test.
- Do a small amount of hip adduction to prevent the consequent abduction during the hip external rotation. This ensures that the hip is in neutral abd/add during the critical step.
- External rotation - this is because piriformis is allegedly an internal rotator above 60-70˚ of hip flexion. External rotation therefore stretches the muscle onto the nerve.
- Knee extension to elongate the sciatic nerve whilst under pressure from piriformis.
- Dorsiflexion or plantarflexion inversion for the tibial or fibular nerve for more tension and/or differentiation.

SEE VIDEO OF THE TECHNIQUE

2025 - NEURODYNAMICS - HAPPY 30TH ANNIVERSARY!!!

PART 1 of 3 - BRIEF HISTORY OF NEURODYNAMICS IN PHYSICAL THERAPY

Where we came from.
Now, what's happening.
Where to in the future.

PART 1

4,800 years ago - first documented neurodynamic test, straight leg raise, Imhotep, Egypt.

1880s
- Neural tension and movements demonstrated in cadavers by European medical doctors.

- Straight leg raise named “Lasègue manoeuvre" (Lazaravic, Lasègue, Forst, Fajerstajn).

1959
- First documentation of all the three neurodynamic tests for the upper limb (median, radial and ulnar) in German anatomy text (Von Lanz & Wachsmuth).

1970s
- Robert Elvey (PT) - brachial plexus tension test, SLR of the upper limb.

- Geoff Maitland (PT) - slump test, first study on normal neurodynamic test responses.

- Dr Alf Breig (neurosurgeon) “Adverse Mechanical Tension in the Central Nervous System”.

1980s

- David Butler (PT) and Louis Gifford (PT), “The Concept of Adverse Mechanical Tension in the Nervous System”.

1990s
- David Butler, Mobilisation of the Nervous System.

1995
- Neurodynamics.

2005
- Clinical Neurodynamics

Courses:
- online:
https://neurodynamicsolutions.com/collections/online-courses

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https://neurodynamicsolutions.com/collections

PART 2. COMING SOON. Clinical System of Neurodynamics for Diagnosis and Treatment - Clinical Neurodynamics.